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<pre><font face="Courier New, Courier, mono"size="2">         To: Fantaisie Software
             10, rue de Lausanne
             67640 Fegersheim
             France

     ********************************* PureBasic *********************************

            I would like to purchase the full version of PureBasic.

     Price per copy: 79 Euro

     Name:    _________________________________________________________

     Address: _________________________________________________________

              _________________________________________________________

              _________________________________________________________

     Country: _________________________________________________________

     Phone:   _________________________________________________________

     EMail:  _________________________________________________________

     All requested information is considered private and personal. It will not be 
     distributed for any reason by Fantaisie Software.

     I am sending the shareware donation via (please mark as appropriate):-

       ( ) Euro cheque. The safer/cheaper method for all European people.

       ( ) Other methods? Prior approval required via EMail. (Approvals will be
           kept as confirmation pending receipt of the registration form).


     Please send me the full program via (please mark as required):-

       ( ) EMail (Login and password to download the full version)

       ( ) Snail Mail (on CD-Rom)

     I have read the terms and conditions and agree to abide by them.


     __________________     ________________________________________

         Date                              Signature



     Notes about PureBasic:
     
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